Magnetoencephalography and Neurobehavioral Outcome of Pediatric Traumatic Brain Injury

创伤性脑损伤（TBI）是美国的一个主要公共卫生问题。的应用 脑磁图（MEG）用于研究儿童TBI的行为结果是创新的，因为 MEG可以识别这些结果的潜在机制。这种潜力来自于MEG是一种 一种功能性神经成像工具，可以检测到在大范围内无法通过MRI检测到的脑损伤的证据。 在大多数轻度TBI病例中，即使在中度至重度TBI中也可能识别出额外的病变。的目标 拟议的项目是研究伤害和心理社会危险因素的发展， TBI患儿的并发症。拟议的研究将包括一项为期3个月的前瞻性评估， 一项对连续治疗的创伤性脑损伤儿童（n=220）和对照组儿童（n = 220）的纵向研究。 骨科损伤（OI）不涉及大脑（n=110）。评估将包括MEG和结构和 功能性磁共振成像行为、精神、神经行为和心理社会变量的有效评估 将被管理。 本研究将探讨四个主要假设：（1）脑磁慢波活动异常及其减少 在创伤后2周至3个月，创伤性脑损伤（TBI）将以更高的程度和更多的脑区发生（愈合） 与OI儿童相比，TBI的严重程度更高。TBI儿童的年龄越小， 恢复将是一段时间。(2)MEG在检测脑损伤区域方面比MRI更敏感和特异。 大脑和改变的连接与TBI和OI的儿童。(3)损伤变量（年龄、MEG慢波、FA， 严重程度，MRI体积指数，脑损伤的存在）将介导脑震荡后症状的变化， 新发精神障碍的发生率，注意功能的变化和儿童的结果 TBI和OI，独立于损伤前儿童变量（适应性，学习和认知功能， 共病精神障碍），伤后儿童变量（适应功能，应对），伤前家庭变量 （家庭功能，社会经济地位，生活事件，家庭精神病史）和损伤后家庭变量 （运作）。(4)与OI相比，TBI儿童在n-back上的表现更差，改善更少 工作记忆任务，并展示了不同的模式MEG信号激活提示额叶- 顶叶功能障碍 该研究将有助于更准确地预测、早期识别和改善精神疾病的治疗。 以及与小儿创伤性脑损伤相关的神经行为并发症。

Traumatic brain injury (TBI) is a major public health problem in the United States. The application of magnetoencephalography (MEG) to the study of behavioral outcome of pediatric TBI is innovative because MEG may discern potential mechanisms for these outcomes. This potential derives from the fact that MEG is a functional neuroimaging tool that detects evidence of brain damage that eludes detection by MRI in the vast majority of cases of mild TBI and likely identifies additional lesions even in moderate to severe TBI. The goal of the proposed project is to study injury and psychosocial risk factors for the development of behavioral complications in children with TBI. The proposed study will involve a 3-month, 2-assessment, prospective longitudinal study of consecutively treated injured children with TBI (n=220) and a control group of children with orthopedic injuries (OI) not involving the brain (n=110). Assessments will include MEG and structural and functional MRI. Validated assessments of behavioral, psychiatric, neurobehavioral, and psychosocial variables will be administered. The study will examine 4 major hypotheses: (1) Abnormal slow-wave MEG activity and its reduction (healing) from 2 weeks to 3 months postinjury will occur in higher magnitude and in more brain areas in TBI versus OI children, and with greater severity of TBI. The younger the age of children with TBI the slower the recovery will be over time. (2) MEG will be more sensitive and specific than MRI in detecting damaged areas of brain and altered connectivity in children with TBI and OI. (3) Injury variables (age, MEG slow waves, FA, severity, MRI volumetric indices, presence of brain lesion) will mediate changes in postconcussion symptoms, occurrence of new-onset psychiatric disorders, and attention function changes and outcome in children with TBI and OI, independent of effects of preinjury child variables (adaptive, academic and cognitive function, and comorbid psychiatric disorders), postinjury child variables (adaptive function, coping), preinjury family variables (family function, socioeconomic status, life-events, family psychiatric history), and postinjury family variables (functioning). (4) Compared with OI, children with TBI will perform more poorly and improve less on an n-back working memory task, and demonstrate a different pattern of MEG signal activation suggestive of frontal- parietal dysfunction. This study will foster more accurate prediction, earlier identification and improved treatment of psychiatric and neurobehavioral complications related to pediatric TBI.